Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 01037956A | IN |
NPI | 1609808492 |
---|---|
Provider Name | Dr. Martin Louis Milgrom |
First Address | Indianapolis, IN 46202-5149 |
Second Address | Indianapolis, IN 46202-5149 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000042347 | ANTHEM (01) | IN |
0004111316 | AETNA (01) | IN |
1437476 | CIGNA (01) | IN |
D63850 | (02) | IN |